Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | DC15809 | CA |
NPI | 1013019850 |
---|---|
Provider Name | Dr. Timothy Joseph Kimble |
First Address | Lake Elsinore, CA 92530-2740 |
Second Address | Lake Elsinore, CA 92530-2740 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 02/09/2006 |
Last Update Date | 06/12/2011 |